Distal clavicular erosion (differential)

Changed by Henry Knipe, 19 Sep 2020

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Erosion or absence of the distal ends of the clavicles may be seen in a wide range of conditions.

Differential diagnosis

Bilateral erosions

~~weightlifter's shoulder~~atraumatic distal clavicular osteolysis: due to repetitive microtrauma; classically described in weightlifters, but can affect anyone performing repetitive overhead lifting and carrying ^3,4
hyperparathyroidism
- subchondral bone resorption; usually symmetric with osteopenia, abnormal trabecular pattern
- the acromion is normal, but the sternoclavicular joint may be affected
rheumatoid arthritis
- bilateral or unilateral changes with soft tissue swelling, subchondral osteoporosis and erosion of the outer third of the clavicle
- acromial erosions may occur later in the disease process
scleroderma
psoriatic arthropathy
cleidocranial dysostosis
pyknodysostosis (rare)
progeria (rare) ⁵

Unilateral erosion

rheumatoid arthritis
post-traumatic distal clavicular osteolysis~~: same pathophysiology as weightlifter's shoulder, only unilateral (e.g. overhead throwers)~~ ^3,4
myeloma
metastases
osteomyelitis

~~-<li>weightlifter's shoulder: due to repetitive microtrauma; classically described in weightlifters, but can affect anyone performing repetitive overhead lifting and carrying 3,4~~
+<li>atraumatic <a title="Distal clavicular osteolysis (DCO)" href="/articles/distal-clavicle-osteolysis">distal clavicular osteolysis</a>: due to repetitive microtrauma; classically described in weightlifters, but can affect anyone performing repetitive overhead lifting and carrying 3,4
~~-<li>post-traumatic osteolysis: same pathophysiology as weightlifter's shoulder, only unilateral (e.g. overhead throwers) 3,4~~
+<li>post-traumatic distal clavicular osteolysis 3,4

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